Artroskopik ön çapraz bağ rekonstrüksiyonusonrası eklem içi bupivakain enjeksiyonuzamanlamasının ve dren klempi durumununpostoperatif ağrı skoru üzerine etkisi

Öz

Amaç: Çalışmanın amacı, artroskopik ön çapraz bağ (ÖÇB) rekonstrüksiyonu sonrası eklem içi lokal anestezik uygulamada zamanlama ve dren durumunun ağrı skoru üzerine etkisini incelemektir.

Çalışma planı: Artroskopik ÖÇB rekonstrüksiyonu uygulanan kırk hasta randomize olarak dört gruba ayrıldı. İntra-artiküler anestezik ajan olarak 20 ml bupivakain tercih edildi. Grup I hastalarına operasyondan 20 dakika önce (Preemptive-PE), Grup II hastalarına ameliyattan sonra ve hemovak dren klempi açık bırakılarak (Drain Open-DO), Grup III hastalarına yine ameliyattan sonra fakat dren klempi 1 saat kapalı kalacak şekilde (Drain Closed-DC) eklem içi enjeksiyon uygulanırken, Grup IV hastaları kontrol grubu olarak seçildi ve herhangi bir eklem içi enjeksiyon uygulanmadı (Control Group-CG). Görsel Analog Skalası (Visual analog scale-VAS) ve ek analjezi gereksinimleri kaydedildi.

Bulgular: Postoperatif 2. saatte PE grubu en düşük, CG grubu ise en yüksek VAS skoruna sahipti. 4. saatte sıralama değişmezken, DC grubunun DO grubu hastalar üzerinde ağrı kontrolü bakımından anlamlı üstünlük sağladığı görüldü (p<0.05). Altıncı saatte PE ve DC grupları aralarında anlamlı fark saptanmazken bu iki grubun VAS skorları diğer gruplardan daha düşüktü (p<0.05). 12. saatte PE ve CG grupları, DC ve DO gruplarına kıyasla daha yüksek VAS skorlarına sahip bulundu. 24. saatte grupların VAS skorları arasında fark saptanmadı. İlk analjezik ihtiyacı CG grubunda diğer gruplara kıyasla anlamlı olarak en erken, PE grubunda ise en geç olmuştur (p<0.001).

Çıkarımlar: Operasyonun farklı periyodlarında yapılan eklem içi bupivakain enjeksiyonu, postopera¬tif dönemde değişken VAS skorları sağlamıştır. Enjeksiyon sonrası drenin klemplenmesi, etki süresini kısaltmadan erken analjezi etkisi oluşturmuştur.

Anahtar Kelimeler

• Dren; bupivakain; ÖÇB rekonstrüksiyonu; postoperatif ağrı; VAS skor.

Do timing of injection and status of the suction drain effect postoperative pain scores after intra-articular bupivacaine injection in arthroscopic ACL reconstruction?

Öz

Objective: The aim of this study was to determine if the timing of intra-articular local anesthetic injection and the status of the suction drain affect variable pain scores after ACL reconstruction.

Methods: The study included 40 patients undergoing arthroscopic ACL reconstruction randomized into 4 groups. Patients in Group 1 received intra-articular 20 ml of 0.25% bupivacaine 20 minutes before the start of the operation (preemptive: PE), Group 2 at the end of the operation with the suction drain opened (DO). Group 3 also received intra-articular bupivacaine at the end of the operation and the drain was kept closed for one hour postoperatively (DC). Group 4 did not receive any intraarticular injection (control group: CG) and served as the control group. Visual analog scale (VAS) scores and additional analgesic requirements were recorded.

Results: The PE group had the lowest and the control group the highest VAS scores at the second postoperative hour. At the fourth postoperative hour, VAS scores were significantly higher in the DC group than the DO group (p<0.05). At the sixth postoperative hour, the PE and DC groups had significantly lower VAS scores than the other groups (p<0.05). At Hour 12, the PE and control groups had higher VAS scores than the DO and DC groups. VAS scores were not different among groups at Hour 24. The interval to first analgesic requirement was significantly shorter in the control group and longer in the PE group in comparison to the other two groups (p<0.001).

Conclusion: Intra-articular bupivacaine injection at different stages of the operation yielded variable VAS scores in the postoperative period. Closing the drain after intra-articular injection resulted in an early onset analgesic effect without shortening the duration.

Anahtar Kelimeler

• ACL reconstruction
• bupivacaine
• drain
• postoperative pain
• VAS score

Kaynakça

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